I will apologize ahead of time for the length of this post but I am upset and need your help. On Friday I had 4 people not home for their visit. I do skilled Medicaid visits and I always tell my patients when my next visit day and if it will be morning or afternoon. Then on the day of my visit I call a couple hours ahead to let them know approximate time 1-1:30 and this usually works. The day that everybody was gone the weather was nice so everybody was out having fun. The problem was no one called to even let me know that they when they would be home, even though they knew this was the policy. I am per diem so I depend on the money not to mention that I am seeing these pts to take care of their meds, give injections, etc.I contacted my supervisor to let her know of all the difficulties and see if she would help try to locate them, she was finally able to find one family but that family said they had no idea that I was coming and that it wasnt written on her calendar and it most definitely was. My other pt. whom I usually see around 1pm finally got home at 2pm and I had already had to drive to other side of town so had to schedule her around 3:30 - 4pm then she was mad at me because when I eventually saw her I was 15 minutes late and she was waiting to go back out and play. How do you all schedule your visits and when do you call your patients to let them know, how do you let them know when something unexpected comes up? I need advice!!! Also do you have a policy like 3 strikes and your out if they dont let you know they wont be home. I am afraid with gas prices I just cant afford to be running back and forth even with mileage reimbursement. Sorry this is so long but we are a very small company and I need help and I needed to vent. Thank You!!!
Last edit by RN relief needed on May 10, '04
May 10, '04
Sounds like what generally happens when people do not have to pay for what you are providing. They feel there is nothing to be lost if there is something better/more interesting for them to do.
Do you have a cell phone? Maybe you can call them first thing in the a.m. to confirm and then when you are about an hour out. Maybe that will be a helpful reminder.
Otherwise, it might be prudent to have a gentle discussion about your willingness to continue to provide services if they are not willing to be available. You cannot do this for free! There is also something to be said about how much home care they need, if they are out gallavanting around instead of being available for their care.
Good luck--and as far as I'm concerned, vent all you want! It's part of the "gift" of this board!
Best to you....
May 10, '04
That is my "rule". Three strikes your out, unless of course your a psyc patient in which going out then is usally good.
I know that is very frustrating.
May 10, '04
Boy... Have you opened a hornets nest with me.. This is one of my BIGGEST pet peeves... I try my best to call all my clients either the day or night before. I get better compliance with calling the night before. When admitting them, I even try to set up specific days I will be there, following MD frequency. At my agency, we usually write a "VARIENCE" to the MD and fax it to him/her. If I know it is going to be a compliance visit problem, I end up usually calling the MD and telling about the issue's I'm having and generally I discharge. My time is too valuable to be tracking these people down. I have about 7 pediatric clients a day to see within an hour radius of the children's hospital I work for. I don't have time or the energy to play their games. I put on about 200 miles a day on my car. I try to really tell the patients or their families if I am running late or whatever. Free healthcare is a privladge and some people could care less wether or not you come or not.
Best of luck and BTW... Are they really eligible to recieve homecare? Remember, it's your name going on the 485 and FRAUD is a big issue with medicaid.
May 10, '04
My thinking is in line with Chris. In my experience being eligible for homecare visits generally infers the person is homebound (except for MD visits).
May 11, '04
Thank you to everybody for your suggestions and listening to me. I definitely need your support. Part of me loves home health but part of me is plain old burned out, and home care can be lonely when you have problems. I definitely agree that some pts dont appreciate the help and privilege of receiving free care. Most of the pts I care for have some psych issues and I do encourage them to get out of the house, just call me 1st and let me know, so we can figure out a time for me to visit (they are medicaid pts so they dont have to be homebound). What upset me so much this time was a gallon of gas is $1.95, then 4 pts werent home, then 2 pts/families lying to my supervisor that they didnt know I was coming, all of this was just too much. I have had quite a few problems with one of my pts compliance and extensive blaming of others for her problems, so for her its either another nurse or agency, as she is making my blood pressure go way up. I spoke with my supervisor today and we discussed that pt and making sure everybody is reminded the day before my visit that I will be there, so I will do that. I do have a cell phone and I did call everybody this eve and gave them a 2 hour range of when I would be out tomorrow, I will also call them tomorrow an hour or two before I visit. Hopefully this will help. Most of my pts have a terrrible time remembering anything - keeping drs appts, compliance with meds or anything and that is huge reason for my visits, so I will keep plugging along. Thanks again for listening, hopefully my pts will remember that I called them this eve and be home tomorrow, I will let you know.
May 11, '04
I posted my days on the client's refrigerator. That helped the forgetful ones.
May 11, '04
Just a quick update as I am tired, but wanted to let you all know that calling the day ahead worked everybody was home today. Thank you for your help!
May 12, '04
Don't give up... It gets better.... Just call if you need more help.. I know how frustrating it can be... Just keep going.. It's worth it!
May 13, '04
I also call the night before, however in Ky you have to be homebound even for Medicaid, unless you are a waiver pt..... and then you are the waiver teams pt. If you are receiving skilled services, you must be homebound and our Medicaid pt have to have auth for each visit. My agency also will dc if you are not homebound, even if you are pysch, because the same guidelines apply. We generally allow one missed visit if for a good reason (funeral, unexpected out of town family visit) but the second one, we discharge the patient. I have found that going over homebound guidelines on admission helps a great deal. Don't give up on homecare, it is the best job I have ever had, even with the occ problem.
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